Influence of intravitreal treatment with angiogenesis inhibitors on functional and morphological findings in the wet form of age-related macular degeneration

Uvod: Senilna degeneracija makule (SDM) je vodeći uzrok ozbiljnog, trajnog oštećenja vida kod ljudi preko pedeset godina života. To je stanje kod koga primarno dolazi do oštećenja fotoreceptora makule. Subretinalna ili horoidalna neovaskularizacija je patološki supstrat za formiranje neovaskularne membrane (SNM) kod vlažne forme senilne degeneracije makule (nSDM). U patogenezi ove membrane značajnu ulogu, ako ne i ključnu, ima angiogenetski faktor, tzv. vaskularni endotelni faktor rasta (VEGF), koji je odgovoran za povećanje vaskularnog permeabiliteta i stimulaciju neovaskularizacije. Zato je jedna od mogućih strategija prevencije i tretmana subretinalne neovaskularne membrane inhibicija VEGF i smanjenje vaskularnog permeabiliteta. Cilj: je da se utvrditi efikasnost i bezbednost intravitrealne primene leka iz grupe ihhibitora VEGF, bevacizumaba u dozi od 1,25 mg (0,1mL) u terapiji nSDM, kao i da li intravitrealna primena ovog leka po PRN protokolu (pro-re-nata, ili po potrebi), utiče na promenu vidne oštrine (poboljšanje/stabilizacija/pogoršanje) i veličinu SNM merene optičkom koherentnom tomografijom (OCT) u periodu praćenja od 44±4 nedelje. Cilj ovog istraživanja je i da se utvrdi eventualni prognostički značaj vidne oštrine i vrste SNM ustanovljene fluoresceinskom angiografijom (FA) i OCT-om na krajnji ishod terapije. Takođe, jedan od ciljeva je i da se utvrde mogući lokalni i sistemsi neželjeni efekti intravitrealno aplikovanog bevacizumaba i njegov potencijalni efekat na promenu u vrednostima sistolnog i dijastolnog arterijskog krvnog pritiska, s obzirom da se lek primenjuje "off label". Metodologija: U retrospektivnu kliničku komparativnu studiju uključeno je 92 pacijenta sa dijagnozom nSDM. Dijagnoza nSDM je ustanovljena kliničkim pregledom, a potvrđena FA i OCT-om. Kriterijum uključenja bio je postojanje SNM tačno definisanog tipa (klasična, minimalno klasična ili okultna)...Introduction: Age-related macular degeneration (AMD) is the leading cause of serious, permanent sight damage after the age of fifty. In this condition macular photoreceptors are the primary sight of damage. Subretinal or choroidal neovascularization is the pathological substrate underlying the formation of a subretinal, choroidal neovascular membrane (CNM) in the wet form of age-related macular degeneration (wet AMD). In the pathogenesis of this membrane an important, if not crucial role is played by an angiogenesis factor known as vascular endothelial growth factor (VEGF), which is responsible for increasing the vascular permeability and stimulating neovascularization. Therefore, one of the possible strategies in the prevention and treatment of subretinal neovascular membrane is inhibition of VEGF and decrease in vascular permeability. Aim: is to determine the efficacy and safety of intravitreal administration of 1.25mg (0.1mL) of the vascular endothelial growth factor inhibitor bevacizumab in the treatment of wet AMD, as well as to determine whether PRN (pro-re-nata, or as needed) application of this drug has any influence on visual acuity (improvement/stabilization/deterioration) and the size of SNM measured by optical coherence tomography (OCT), in the follow-up period of 44±4 weeks. The aim of this research is also to determine the prognostic importance of visual acuity and CNM type determined by fluorescein angiography (FAG) and OCT on the outcome of treatment. Moreover, one of the aims is to determine the possible local or systemic side effects of the intravitreal application of bevacizumab and its potential effects on systolic and diastolic blood pressure, considering the “off label” application of the drug. Methodology: A total of 92 patients with the diagnosis of wet AMD were included in the retrospective clinical comparative study. The diagnosis of wet AMD was established by physical exam, and confirmed on FAG and OCT. The inclusion criterion was the existence of a particular type of SNM (classic, minimally classic or occult)..

Contrast sensitivity in patients with diabetes mellitus

Introduction: Diabetic retinopathy is one of the major complications of diabetes mellitus. It is a progressive disease that includes following stages: no apparent DR, non-proliferative DR and proliferative DR. Contrast sensitivity is defined as the ability to distinguish details at low contrast levels. Numerous studies have shown that in patients with DR, in stages when visual acuity is normal or only mildly reduced, CS function is significantly affected. Aim: The aim of our study was to examine whether CS is reduced in patients with diabetes, and whether is it significantly lower in diabetic patients compared to healthy subjects. Material and methods: 20 patients with diabetes treated at Hospital for Eye Diseases, Clinical Center of Serbia and 20 healthy subjects from general population participated in the study. We have conducted case-control study. We used low-contrast ETDRS chart to measure CS. Results: CS in diabetic patients was compared with CS in healthy subjects. We also examined CS in diabetics with and without retinopathy. A statistically significant difference was ob served between the patients and the control group, both at monocular and binocular vision and the diseased persons had significantly impaired CS function. Regarding the stage of retinopathy, statistical significance existed only in monocular vision, in terms of decreased CS in patients with non-proliferative DR. Our study shows that there was no statistically significant difference in CS in diabetics with hemoglobin A1c lower than 7 and in those with hemoglobin A1c equal or higher than 7. Conclusion: Our research found that CS in diabetic patients can be greatly impaired, even in early stages of disease, while there were still no retinal abnormalities. In view of the fact that in all of our respondents visual acuity was normal, we conclude that measuring CS, could be good indicator of early vision disorders in diabetic patients

Metabolic syndrome and central retinal artery occlusion

Background. The accumulation of risk factors for central retinal artery occlusion can be seen in a single person and might be explained by the metabolic syndrome. Case report. We presented the case of a 52-year-old man with no light perception in his right eye. The visual loss was monocular and painless, fundoscopy showed central retinal artery occlusion and the laboratory investigation showed the raised erythrocyte sedimentation rate of 105 mm/h and the raised C-reactive protein of 22 mg/l. Specific laboratory investigations and fluorescein angiography excluded the presence of vasculitis, collagen vascular diseases, hypercoagulable state and antiphospholipid syndrome. Conclusion. The patient met all the five of the National Cholesterol Education Program (NCEP) criteria for the metabolic syndrome: hypertension, abnormal lipid profile, abnormal glucose metabolism, obesity and hyperuricemia. Measurement of C-reactive protein is useful for the assessment of therapeutic systemic effect on any abnormality in the metabolic syndrome. Individual therapy for all risk factors in the metabolic syndrome is necessary to prevent complications such as cardiovascular, retinal vascular diseases and stroke

Anthropometric and lipid parameters trends in school children: One decade of YUSAD study

Introduction. Athersclerosis is a multifactorial disease that begins in childhood. There are few reports regarding influence of risk factors on the atherosclerotic processes in early period of life and adolescence. Objective. The aim of this study was to present and analyze risk factor trends in school children over a 10-year period that were included and followed-up by the Yugoslav Study of Atherosclerosis Precursors in School Children (YUSAD Study). Methods. There were three examinations of selected population from 13 centres. The first examination was performed when children were 10 years of age (first group; N=6381 participants), the second examination on the same population when they were 15 years of age (second group; N=5017) and third when children were 19/20 years of age (third group; N=1293). Evaluated parameters included: BMI, waist circumference (WaC) and lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride). Results. A significant elevation of values (p<0.001) of BMI, WaC and triglycerides and a significant decline (p<0.001) of total cholesterol and LDL cholesterol in boys over 5 and 10-year period was noticed. There was a significant elevation (p<0.001) of BMI, WaC and HDL values and a significant decline in LDL cholesterol values in girls over the 5 and 10-year period. Conclusion. Our results point out that girls between 10 and 19/20 years have a better lipid profile during growth. It should be stressed out that childhood and adolescence can be more beneficial in the observation of risk factor influences on pathological, genetic and clinical levels

Influence of intravitreal treatment with angiogenesis inhibitors on functional and morphological findings in the wet form of age-related macular degeneration

Uvod: Senilna degeneracija makule (SDM) je vodeći uzrok ozbiljnog, trajnog oštećenja vida kod ljudi preko pedeset godina života. To je stanje kod koga primarno dolazi do oštećenja fotoreceptora makule. Subretinalna ili horoidalna neovaskularizacija je patološki supstrat za formiranje neovaskularne membrane (SNM) kod vlažne forme senilne degeneracije makule (nSDM). U patogenezi ove membrane značajnu ulogu, ako ne i ključnu, ima angiogenetski faktor, tzv. vaskularni endotelni faktor rasta (VEGF), koji je odgovoran za povećanje vaskularnog permeabiliteta i stimulaciju neovaskularizacije. Zato je jedna od mogućih strategija prevencije i tretmana subretinalne neovaskularne membrane inhibicija VEGF i smanjenje vaskularnog permeabiliteta. Cilj: je da se utvrditi efikasnost i bezbednost intravitrealne primene leka iz grupe ihhibitora VEGF, bevacizumaba u dozi od 1,25 mg (0,1mL) u terapiji nSDM, kao i da li intravitrealna primena ovog leka po PRN protokolu (pro-re-nata, ili po potrebi), utiče na promenu vidne oštrine (poboljšanje/stabilizacija/pogoršanje) i veličinu SNM merene optičkom koherentnom tomografijom (OCT) u periodu praćenja od 44±4 nedelje. Cilj ovog istraživanja je i da se utvrdi eventualni prognostički značaj vidne oštrine i vrste SNM ustanovljene fluoresceinskom angiografijom (FA) i OCT-om na krajnji ishod terapije. Takođe, jedan od ciljeva je i da se utvrde mogući lokalni i sistemsi neželjeni efekti intravitrealno aplikovanog bevacizumaba i njegov potencijalni efekat na promenu u vrednostima sistolnog i dijastolnog arterijskog krvnog pritiska, s obzirom da se lek primenjuje "off label". Metodologija: U retrospektivnu kliničku komparativnu studiju uključeno je 92 pacijenta sa dijagnozom nSDM. Dijagnoza nSDM je ustanovljena kliničkim pregledom, a potvrđena FA i OCT-om. Kriterijum uključenja bio je postojanje SNM tačno definisanog tipa (klasična, minimalno klasična ili okultna)...Introduction: Age-related macular degeneration (AMD) is the leading cause of serious, permanent sight damage after the age of fifty. In this condition macular photoreceptors are the primary sight of damage. Subretinal or choroidal neovascularization is the pathological substrate underlying the formation of a subretinal, choroidal neovascular membrane (CNM) in the wet form of age-related macular degeneration (wet AMD). In the pathogenesis of this membrane an important, if not crucial role is played by an angiogenesis factor known as vascular endothelial growth factor (VEGF), which is responsible for increasing the vascular permeability and stimulating neovascularization. Therefore, one of the possible strategies in the prevention and treatment of subretinal neovascular membrane is inhibition of VEGF and decrease in vascular permeability. Aim: is to determine the efficacy and safety of intravitreal administration of 1.25mg (0.1mL) of the vascular endothelial growth factor inhibitor bevacizumab in the treatment of wet AMD, as well as to determine whether PRN (pro-re-nata, or as needed) application of this drug has any influence on visual acuity (improvement/stabilization/deterioration) and the size of SNM measured by optical coherence tomography (OCT), in the follow-up period of 44±4 weeks. The aim of this research is also to determine the prognostic importance of visual acuity and CNM type determined by fluorescein angiography (FAG) and OCT on the outcome of treatment. Moreover, one of the aims is to determine the possible local or systemic side effects of the intravitreal application of bevacizumab and its potential effects on systolic and diastolic blood pressure, considering the “off label” application of the drug. Methodology: A total of 92 patients with the diagnosis of wet AMD were included in the retrospective clinical comparative study. The diagnosis of wet AMD was established by physical exam, and confirmed on FAG and OCT. The inclusion criterion was the existence of a particular type of SNM (classic, minimally classic or occult)..

Terson’s syndrome: A report of two cases

Introduction. Vitreous or retinal hemorrhage occurring in association with subarachnoid hemorrhage is known as Terson’s syndrome. In Terson’s syndrome, intracranial hemorrhages are followed by intraocular hemorrhage, classically in the subhyaloid space, but may also include subretinal, retinal, preretinal, and vitreal collections. Vitreous hemorrhage recovery is usually spontaneous in six to 12 months, otherwise vitrectomy is considered. Outline of Cases. We report of two cases of Terson’s syndrome. The first was in a hypertensive middleaged female, following anterior communicating artery aneurismal subarachnoid hemorrhage, after postneurosurgical interventions. The second case report was of a young male who suffered from the bilateral vitreous hemorrhage after a severe traumatic brain injury. Conclusion. Terson’s syndrome should be considered in patients who had previous cerebral hemorrhage and are referred to eye specialist because of loss of vision. However, this phenomenon has only rarely been described in association with subdural and epidural hematomas or traumatic subarachnoid hemorrhage

Switching therapy in patients with age-related macular degeneration, diabetic macular edema and cistoid macular edema due to retinal vein occlusion

Introduction. Intravitreal injection of anti-vascular endothelial growth factor(VEGF) agents has revolutionized the management of age-related maculardegeneration (AMD), diabetic macular edema (DME), macular edemain retinal vein occlusions (RVO), and other retinal diseases accompanied byneovascular and macular edema. The aim of the study is to show the effectof switching from bevacizumab to aflibercept in patients with recalcitrantwet AMD as the best clinical approach and regimen for patients with neovascularand macular edema accompanied retinal diseases.Methods. All our patients received the intravitreal injections of 1.25 mg(0.1 mL) bevacizumab as the first treatment option, and we switched toaflibercept or triamcinolon acetonid when the therapy including bevacizumabseemed not to be effective enough, according to visual acuity andoptical coherent tomography (OCT) findings.Case presentations. We presented four cases: two patients with wet AMD,one patient with macular edema due to central retinal vein occlusion (CRVO)and one patient with DME in non-proliferative diabetic retinopathy (nPDR).The majority of our patients felt visual and anatomical improvement. Somepatients felt anatomical improvement although their visual acuity did notimprove. Switch to aflibercept had prolonged the positive effect of bavacizumabfor approximately 2 months. When regular therapy including bevacizumabwas reintroduced, the therapeutic effect would be prolonged.The effective clinical approach was not only the switching therapy but thecombination therapy as well. Individual treatment approach and pro renata regimen were most commonly used in our patients.Conclusion. Switching anti-VEGF drug showed positive results in patientswith refractory or recurrent wet AMD and macular edema

Optic Disc Abnormalities – Diagnosis, Evolution and Influence on Visual Acuity

Congenital abnormalities of the optic disc are not so rare. The etiology for the most of them is unknown. Visual acuity of affected eye may be minimally or severely affected, depending on the extent of lesion. All of these conditions can be unilateral or bilateral. Chíldren who have unilateral optic disc abnormalities generally present during the preschool years with sensory esotropia. Visual acuity may be unaffected like in optic disc pit, optic disc drusen, fibre medullares, ect. However, during the evolution they may cause a decrease in visual acuity like serous retinal detachment in optic disc pit, atrophy or subretinal neovascularisation in optic disc drusen. Some of them like fibre medullares needs only a good diagnose and they do not have any evolution. Fluorescein angiography and ultrasonography may be crucial diagnostic procedures to discover some of them, like optic disc drusen. Optic disc abnormalities may be associated with other congenital disorders of the eye and often central nervous system malformations. Secondary they may be associated retinal detachment, retinochisis, macular edema, choroid neovascularisation and lipid exudation. Some of these conditions may be found on routine ophthalmologic exam such as optic disc drusen and fibre medullares and often are diagnostically problem. The aim of our study was to present some of our cases with different optic disc abnormalities such as fibre medullares, optic disc coloboma, hypoplasio disci, optic disc drusen and optic disc pit

Macular Parameters Change during Silicon Oil Tamponade for Retinal Detachment Surgery

Background and Objectives: To evaluate possible changes in macular thickness parameters during and after silicon oil tamponade and in pars plana rhegmatogenous retinal detachment surgery. Materials and Methods: Our retrospective study included 34 consecutive patients who underwent 23-gauge retinal detachment surgery with silicon oil tamponade. Central macular thickness (CMT), central macular volume cube (CMV) and average macular thickness cube (AVG) were measured by optical coherence tomography (OCT) before rhegmatogenous retinal detachment surgery with silicon oil tamponade during tamponade (seven days, one month and three months after surgery), and one month after silicon oil removal. Results: In our sample, macular parameters CMT, CMV and AVG in patients who underwent retinal detachment surgery were statistically reduced during silicon oil tamponade (p < 0.05). After silicon oil removal, all parameters recovered, reaching numeric values which were not statistically significant compared to preoperative values. The average span of silicon oil tamponade was 162 +/− 23 days. Conclusions: Silicon oil tamponade during 23-gauge rhegmatogenous retinal detachment surgery leads to a transitory reduction of central macular thickness, central macular volume cube and average macular thickness cube in eyes that underwent retinal surgery. After silicon oil removal, macular parameters returned to preoperative values in most of the patients

Macular Parameters Change during Silicon Oil Tamponade for Retinal Detachment Surgery

Background and Objectives: To evaluate possible changes in macular thickness parameters during and after silicon oil tamponade and in pars plana rhegmatogenous retinal detachment surgery. Materials and Methods: Our retrospective study included 34 consecutive patients who underwent 23-gauge retinal detachment surgery with silicon oil tamponade. Central macular thickness (CMT), central macular volume cube (CMV) and average macular thickness cube (AVG) were measured by optical coherence tomography (OCT) before rhegmatogenous retinal detachment surgery with silicon oil tamponade during tamponade (seven days, one month and three months after surgery), and one month after silicon oil removal. Results: In our sample, macular parameters CMT, CMV and AVG in patients who underwent retinal detachment surgery were statistically reduced during silicon oil tamponade (p Conclusions: Silicon oil tamponade during 23-gauge rhegmatogenous retinal detachment surgery leads to a transitory reduction of central macular thickness, central macular volume cube and average macular thickness cube in eyes that underwent retinal surgery. After silicon oil removal, macular parameters returned to preoperative values in most of the patients